How a Bad Flu Season Can Affect Skilled Nursing Admissions, Staffing

By Carlo Calma | January 18, 2018

For the first time in more than a decade, the U.S. Centers for Disease Control and Prevention (CDC) is reporting widespread cases of the flu in 49 states — and the historic bug could have an effect on nursing providers’ bottom lines.

In fact, in the 13 years that the CDC has been conducting surveillance studies on flu activity in the country, this season is the first time the agency has seen the entire continental U.S. be the same color on its “FluView” map, according to Dr. Dan Jernigan, director of the influenza division in CDC’s National Center for Immunization and Respiratory Diseases.

“[This means] there’s widespread activity in all of the continental U.S. at this point,” Jernigan said. “It is in a lot of places and causing a lot of flu.”

Jernigan, alongside CDC director Brenda Fitzgerald, addressed the nation’s pandemic flu season during a press briefing in early January.

Making matters worse, the most common form of the flu this season — influenza A, H3N2 — is a particularly strong strain of the influenza virus, according to Fitzgerald.

“These viruses are often linked to more severe illness, especially among children and people age 65 and older,” Fitzgerald said during the briefing. “When H3 viruses are predominant, we tend to have a worse flu season with more hospitalizations and more deaths.”

This is certainly the case this year, as the CDC is seeing a “very rapid increase” in the number of people coming in to see their doctors or health care professionals among the roughly 2,000 providers who supply the agency with data, according to Jernigan.

Operational strains

For skilled nursing facilities, a particularly bad flu season can have an immense impact on business metrics, according to Linda Behan, director of infection prevention and control at Kennett Square, Pa.-based Genesis HealthCare (NYSE: GEN).

“Certainly, when you have more admissions, it always helps revenue, [but] there’s also the downside — where sometimes, if you should have a very bad flu outbreak in your center, in order to control the spread of the illness, we’ll actually restrict admissions,” Behan told Skilled Nursing News.

In nearly every region where Genesis operates, the skilled nursing provider is seeing an increase in the number of flu cases this season, Behan explained.

When it comes to restricting admissions, leadership relies on reports from their local departments of health, she added.

“The department of health will always make recommendations, but our vice president of medical affairs, who gets daily updates, will also make determinations about restricting any admissions,” Behan said. “That’s based not just on number [of cases] but geographic location, done by a center-by-center decision.”

This practice of restricting admissions to prevent further infections is also followed by leadership at Newton, Mass.-based Five Star Senior Living (NASDAQ: FVE).

But in addition to restricting admissions, a flu outbreak within a SNF can also put a strain on its day-to-day resources, explained Rob Poyas, vice president of sales and marketing at Five Star.

“Our staff is having to work harder, [so] you also run the risk of your staff getting sick,” Poyas told SNN. “We have to keep the staffing up so you’re going to get some overtime costs in with it; a lot of times we have to bring in extra staff.”

Staffing and pharmacy costs can go up during a flu outbreak in a SNF, but so can non-medical expenditures, Poyas added.

“Even food costs could go up, because you’re going to start altering your service; like if your community’s restaurant is closed, then you will be individually delivering each meal to each resident’s apartment,” he said. “It could even change the contents of what you’re delivering.”

An elementary approach

To curb the operational and financial strains associated with a flu outbreak, preventing the spread of the virus is key, according to the experts.

Leadership at Five Star Senior Living accomplish this by following guidelines established by the CDC.

This involves common practices like frequent hand washing and increasing the facility’s daily cleaning schedules, according to Poyas.

At Genesis, prevention starts with getting residents and staff vaccinated against the flu. Employees who opt out of getting a flu vaccine, on the other hand, are asked to wear surgical face masks, Behan explained.

To help with any staffing strains during a flu outbreak, leadership at Five Star will keep staff contained, according to Poyas.

“One good best practice is we keep the same staff working with the same residents, so we try to eliminate floaters,” he said. “[Instead of staff] going out to the whole community you try and isolate certain key members with certain groups of residents.”

Another component to combatting the flu for Genesis is “proactive surveillance,” Behan explained.

“This is where the infection prevention [staff] in our centers are actively, on a daily basis, looking for patients or staff, or even visitors, who are displaying signs and symptoms of respiratory illness. If we think it could possibly be flu for our patients, we will do testing to see if the influenza virus is identified,” she said.

At Five Star, patients found to have been infected with the flu virus are quarantined, and to prevent further spread of the infection, visiting hours and group activities may be limited, according to Poyas.

“From the care side, you have to step up the monitoring for all the residents just so that you look for changing health conditions,” he said. “And then, it’s reporting everything to the local health department and then seek guidance and best practices from them. Our whole goal is to be collaborative so we can care for our residents to the best of our abilities.”

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